In any given year, approximately 3.5 million Americans experience homelessness, 39 percent of whom are children. Why we allow so many people to live in abject poverty and desperation is an indictment against our humanity; it most certainly tarnishes the badge our nation flashes to the rest of the world when we claim to be the standard bearer on human rights. In partial defense, though, those who study homelessness readily acknowledge that lasting solutions are elusive because homelessness is a multidimensional and complex problem.

Though no statistics are kept on the numbers of homeless treated by hospitals in Los Angeles, 75 hospitals with emergency rooms are the medical safety net for the estimated 80,000 homeless residing in the county, including the almost 1,200 who congregate daily on the streets of Skid Row in downtown Los Angeles. In fact, these hospitals are required by law to receive, treat and stabilize any of the county's almost 3 million uninsured residents who present with life-threatening illnesses or injuries, and they meet this obligation at a collective financial loss of approximately $1.6 billion annually.

The burden of being the medical safety net for the uninsured has damaged the integrity of the emergency medical services system we all rely on. Ten hospital emergency rooms serving communities throughout our county closed in the last five years. Of the remaining emergency rooms, at any given time one in four is closed to emergency ambulance patient deliveries because overcrowded conditions threaten to compromise safety and the quality of medical care delivered. Overcrowded conditions also are the root cause of the seven-hour average emergency room waiting times for non-emergency medical treatment.

These conditions compel doctors to discharge patients as soon as the medical condition that brought them in no longer requires acute hospital attention and treatment. Costs have to be constrained to keep more emergency rooms from closing and scarce hospital beds must be cleared quickly of patients no longer needing medical treatment to make way for new patients. Before patients leave the hospital, though, discharge planners try to arrange for the services that the patient-care team says are needed. This process is often complicated by the fact that too few shelter beds and support services are available for homeless patients.

On behalf of hospitals serving communities throughout Los Angeles County, the Hospital Association of Southern California is working with non-profit organizations, the L.A. County Health Department and homeless service agencies to address the issues that Los Angeles City Attorney Rocky Delgadillo raised last November with regard to homeless patients being sent to Skid Row in downtown Los Angeles after being treated by hospitals. In response, the association is very close to completing plans that would connect patients no longer needing hospital care with transitional services.


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